Healthcare Provider Details

I. General information

NPI: 1265597207
Provider Name (Legal Business Name): HILLSIDE HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 23RD AVE
MISSOULA MT
59803-1137
US

IV. Provider business mailing address

1107 HAZELTINE BLVD STE 200
CHASKA MN
55318-1070
US

V. Phone/Fax

Practice location:
  • Phone: 406-251-5100
  • Fax: 406-251-4278
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number755
License Number StateMT

VIII. Authorized Official

Name: JAMES A. WEICHERT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 952-361-8000